House Staff Choosing Wisely: A Partnership Among House Staff, Faculty, and Administration to Integrate the Provision of High-Value Care with Graduate Medical Education

Description

The Vanderbilt House Staff Choosing Wisely Committee formed in December 2013 to improve the cost-effectiveness of test ordering habits amongst all physicians at Vanderbilt University Medical Center and train house staff as quality improvement and change management leaders. We sought to do this by identifying Choosing Wisely recommendations relevant to our medical center, providing educational sessions to house staff, creating evidence-based supportive educational materials, providing real-time test ordering data to on-service providers, and educating ourselves about change management strategies. As described later in our application, we identified reducing unnecessary daily laboratory testing (complete blood counts (CBC's) and basic metabolic panels (BMP's)) as our initial project. Our interdepartmental committee chose as its initial target our general medicine services. We provided an educational intervention at a well-attended teaching conference, disseminated an evidence-based guide to the benefits of reducing unnecessary daily laboratory testing, and initiated real-time data feedback.

This initiative had such rapid success (over 20% absolute reductions in daily CBC and BMP ordering rates within the first two months) on our teaching general medicine services that it has now been expanded to include our non-teaching general medicine services, general neurology, stroke, oncologic/endocrine surgery, trauma surgery, and gastroenterologic/laparoscopic surgery services and soon will expand to our medical intensive care unit. The step-wise success of our work has been met with progressive increases in institutional investments on our behalf. We have received data analyst support to create a real-time lab order tracking dashboard, we have been integrated into our institution's Diagnostic Laboratory Advisory Committee, and we participate in regular report-outs to our Chiefs of Staff to assist with scaling and expanding our work. What began with a handful of residents from different departments tallying lab orders on four inpatient services is burgeoning into an institution-wide system to improve cost-effective test ordering practices.